诱导化疗加放疗同步化疗非小细胞肺癌的疗效观察

目的探讨诱导化疗加三维适形放疗(3DCRT)联合顺铂单药(每周用药)同步化疗不可手术的局部晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法 58例局部晚期NSCLC患者(ⅢA期35例,ⅢB期23例)先接受2个周期的诱导化疗,再同步行3DCRT(Dt 56～70 Gy,中位66 Gy)和顺铂(25 mg/m2,每周1次,共6～7周)化疗。结果诱导化疗后2例达CR,23例达PR,有效率(CR+PR)为43.1%。同步化放疗后6例达CR,36例达PR,有效率为72.4%。全组中位生存期和中位无进展生存期分别为15.8个月和11.2个月,1、2、3年总生存率和无进展生存率分别为62.1%、46.6%、22.4%、和43.1%,15.5%,6.9%。ⅢA期和ⅢB期的中位生存期、中位无进展生存期分别为18.4个月和14.3个月、11.2个月和9.8个月。主要的不良反应为放射性食管炎、放射性肺炎、恶心、呕吐和白细胞减少等。治疗后31例肿瘤局部复发或(和)远处转移,其中3例照射野内复发,4例癌性胸腔积液,24例远处转移。结论诱导化疗后3DCRT+顺铂单药同步化放疗不可手术的局部晚期NSCLC的疗效和耐受性较好,可进一步研究。

Results of Induction Chemotherapy Followed by Concurrent Chemoradiation in Unresect-able Locally Advanced Non-small Lung Cancer

Objective To study the toxicity and efficacy of induction chemotherapy followed by concurrent cisplatin chemotherapy and therr dimensional conformal radiotherapy（3DCRT） for inoperable locally advanced non-small cell lung cancer（LA-NSCLC）.Methods 58 patients with LA-NSCLC received two cycles of induction chemotherapy followed by 3DCRT with a median dose of 66 Gy（56 to 70 Gy）.During the 3DCRT,cisplatin（25 mg/m2,weekly）was given intravenously for 6～7 times.Results after induction chemotherapy,2 cases had CR,and 23 cases had PR,with a overall response rate（CR＋PR） of 43.1%.After concurrent chemoradiotherapy,6 patients had CR and 36 patients had PR,so the overall response rate was 72.4%.The median survival time（MST） and median progression-free survival（PFS） of all patients were 15.8 months and 11.2 months.The 1-,2-and 3-year overall survival（OS） and PFS rates were 62.1%,46.6%,22.4% and 43.1%,15.5%,6.9%.Of patients with stage ⅢA and stage ⅢB disease,the MST were 18.4 months and 14.3 months,the PFS were 11.2 months and 9.8 months.The major treatment-related toxicities included radiation induced esophagitis,radiation induced pneumonitis,nausea（or vomiting） and leukopenia,etc.Thirty-one patients experiencedlocal recurrence or/and distant metastasis,including 3 with in-field failure,24 distant metastasis and 4 malignant pleural effusion.Conclusion Induction chemotherayp followed by concurrent weekly cisplatin and 3DCRT for inoperable locally advanced NSCLC results in encouraging outcomes and acceptable tolerance.